Nursing
Permanent URI for this collectionhttps://eresearch.qmu.ac.uk/handle/20.500.12289/24
Browse
618 results
Search Results
Item P-114 Towards a bereavement-friendly university: reflections from a university hospice partnership(British Medical Journal Publishing Group, 2025-11-21) Young, Julie; Gardner, Hilary; Tsiris, Giorgos; Beveridge, Joanna; Haraldsdottir, Erna; Hastings, Donna; Elliot, Michelle; Dick, Suzie; Doherty, Beth; Donnelly, Kirsty; Reid, Muriel; Green, Gayle; Mountain, Kristina; Mathieson, Vivian; Luhanga, Lisa; Lansdown, Katrina; Longo, Giacinta; Taylor,ElisabethBackground: The UK Commission on Bereavement states that it is incumbent on society to work together to support those affected by bereavement (UK Commission on Bereavement. Bereavement is everyone’s business: Scotland briefing. 2022), and the Scottish Bereavement Summit Report recommends that bereaved people be supported in their workplace (Good Death, Good Life, Good Grief. Scottish Bereavement Summit final report. 2023). Scotland’s first Bereavement Charter for Children and Adults was developed by a coalition of organisations and launched in 2020. This Charter is human rights-based and provides a set of statements on how bereaved people can be supported (NHS Education Scotland. Scotland launches its first human rights-based Charter for Bereavement. [new item] 2020 Apr 15). To guide organisations to become bereavement-friendly workplaces, the Bereavement Charter Mark (Good Death, Good Life, Good Grief. Bereavement Charter Mark. 2020 [internet]) can be achieved by taking specific actions that demonstrate it is a workplace where staff feel supported in their experiences of loss and grief. Aim: To demonstrate the development of Queen Margaret University as a bereavement-friendly workplace through its partnership with St Columba’s Hospice Care. Method The initial working group consisted of staff from the Divisions of Nursing and Paramedic Science, and Occupational Therapy and Arts Therapies. Working in collaboration with hospice staff, the group achieved the Charter Mark. Since then, the group expanded to incorporate staff from across the university, including Human Resources, and has begun to coordinate the development and implementation of an action plan. This plan aims to create the conditions for bereaved staff to feel supported by the people around them, the university’s governance and its culture. Results: Achievement of the Charter Mark has initiated the group to support the review of the university’s bereavement and compassionate leave policies and facilitate two university-wide events focusing on death, grief and bereavement. Conclusion: Through the university hospice partnership, awarding of the Charter Mark and the work of the group, Queen Margaret University is developing the conditions for a sustainable, bereavement-friendly organisation. Learnings have also emerged regarding the crucial role of partnership work for building caring capacity within organisations.Item P-226 Adapting higher education to meet the learning needs of the workforce in palliative care: a university hospice partnership approach(British Medical Journal Publishing Group, 2025-11-21) Young, Julie; Gardner, Hilary; Tsiris, Giorgos; Haraldsdottir, Erna; Cruickshank, Fiona; Williams, ElvinBackground In Scotland, people are living longer, the prevalence of chronic conditions is rising, and the need for palliative care is projected to increase significantly (Finucane, Bone, Etkind, et al. BMJOpen. 2021;11:e041317). Specifically, there is a need for increased capacity in specialist and generalist palliative care skills (Scottish Government. Palliative and end-of-life care strategy aims principles and priorities. Scottish Government; 2023). The changing landscape is compounded by Scotland’s healthcare staffing crisis (Royal College of Nursing. The nursing workforce in Scotland 2024 report. Royal College of Nursing, Scotland; 2024). The workforce faces evolving needs, not least the need for healthcare professionals to hold sufficient knowledge to support the delivery of palliative care (Hospice UK. The future of hospice care in Scotland. Hospice UK; 2021). In line with strategy (The Scottish Government. Palliative care strategy: Palliative Care Matters for All. Scottish Government; 2024), a key component of the partnership between St Columba’s Hospice Care and Queen Margaret University is the education of healthcare professionals working with people with palliative care needs. The university hospice partnership supports the provision of two higher education programmes and contributes to the palliative care curriculum across the university. Aim: To outline how the university hospice partnership has helped to widen accessibility and increase the flexibility of palliative care higher education for health professionals. Method: The following changes have been introduced to the programmes since 2022: a move to online delivery, introducing asynchronous learning opportunities, increasing module choice, opening to applicants globally, and advertising the option to access our modules as stand-alone or electively from other programmes. Results: Our responsive approach increased accessibility and engagement, to include students from a wider range of disciplines and geographical locations. There has been a consistent number of students accessing our programmes. Increasingly, however, potential applicants face barriers to accessing funding and support from their employers. Conclusion: Our responsive and ongoing adaptive approach has widened the student demographic. Increasingly, healthcare professionals face significant challenges in accessing the support necessary to engage with higher education. The university partnership recognises that to meet the ongoing educational needs of the workforce, it is crucial to continue with our responsive, flexible and adaptable approach.Item Portal hypertension and varices: pathophysiology and clinical management(RCN Publishing (RCNi), 2025-12-15) Price, NatashaPortal hypertension is a condition that describes increased pressure within the portal vein, an important structure that drains blood from the gastrointestinal tract and conveys it to the liver. This article describes the normal structure of the liver and its circulation. It also explains how cirrhosis leads to the development of portal hypertension and varices, and considers the latest evidence and guidance for safe clinical management. As liver disease is a leading cause of morbidity and mortality, nurses commonly encounter patients experiencing the effects of portal hypertension in practice, and professional bodies have highlighted a need for increased foundational nursing knowledge to enable informed care and optimise patient outcomes. Therefore, this article aims to enhance nurses’ knowledge of the underlying pathophysiology, clinical manifestations and recommended management of portal hypertension and varices in the context of end-stage liver disease, with specific consideration of the nurse’s role.Item Using a person-centred model of Lean Six Sigma to support process improvement within a paediatric primary eye care clinic(Emerald, 2025-12-11) Bourke, Christine; Mullaniff, Aaron; Tang, Bobby; Waya, Oriyomi; Teeling, Sean PaulPurpose Process improvement methodologies such as Lean Six Sigma are increasingly being deployed to address inefficiencies in healthcare. Simultaneously, global policy and strategy development stress the value of person-centredness in healthcare. This paper examines the application of a Person-Centred Lean Six Sigma Model (PCLSSM) to improve processes in a paediatric eye care clinic, specifically focusing on streamlining the referral system and optimising the clinic environment. Design/methodology/approach A quasi-experimental, single-site, pretest–posttest study was conducted over nine months using the Lean Six Sigma define, measure, analyse, improve and control (DMAIC) framework. Data were gathered through Voice of the Customer (VOC) sessions, Gemba observations, process mapping and referral letter audits. Key stakeholders, including clinicians, administrative staff and parents, co-designed the interventions to enhance efficiency and patient experience. Findings The application of the PCLSSM resulted in a 46% increase in right-first-time referral accuracy, a 20% reduction in referral processing time, a 13% increase in staff confidence in the referral system, a 158% improvement in staff satisfaction with workload and a 104% rise in child and parent satisfaction with their clinic experience. The implementation of an electronic referral system and an improved clinic environment contributed to these improvements. Originality/value This study is the first to integrate a person-centred approach with Lean Six Sigma in paediatric ophthalmology. The findings demonstrate the potential of combining process improvement methodologies with person-centred principles to enhance operational efficiency and stakeholder satisfaction. This approach can serve as a model for similar outpatient settings seeking to improve service delivery and patient experience.Item Person-centred approach for people with learning disabilities in palliative care: the challenges(Queen Margaret University, Edinburgh, 2025-11-30) Wilson, Ashleigh; Young, Julie; Haraldsdottir, ErnaBackground People with a learning disability (PWLD) are living longer with a greater need for palliative care. Research has identified that people with a learning disability experience challenges when accessing palliative care with concerns that person-centred care is not being achieved. Aim The overall aim of this study is to present a meta-synthesis of qualitative studies. Focusing on the challenges of achieving person-centred care for PWLD and palliative care needs, to gain a deeper understanding of the challenges they experience. Method A qualitative meta-synthesis literature review using a seven-phased model by Noblit and Hare was undertaken. An online literature search was conducted between 8 July 2024 and 31 July 2024 across four databases: SAGE publications, PubMed, Wiley Online Library and CINAHL. Results 10 studies were reviewed with 226 participants ranging from PWLD, support workers, health professionals and family members. Main themes identified were: a deficiency of knowledge, the importance of the environment, challenges in achieving effective communication and advance care planning to achieve better outcomes. Conclusion This qualitative meta-synthesis identifies the challenges of achieving person-centred care for PWLD and palliative care needs. It draws attention to person-centred theory and how this supports good person-centred care for PWLD. This paper went further to identify how person-centred theory links with the wider context of healthcare practice while exploring recommendations to improve practice and gaps in research.Item Medical Rehabilitation for Life Changing Conditions [Editorial](Mark Allen Group, 2025-11-25) Jesudason, Edwin C…the experienced doctor thinks in larger units of time, not just backward to cases in the past but, more interestingly, forward, trying to see into the patient’s indeterminate future. (Sennett, 2008, p247) …the meanings of stories are found, and from them people draw both moral and practical guidance on how to carry on. (Ingold, 2011, p210) What makes a condition life changing? Lasting physical impairment is one answer. Another, perhaps less obvious, is the disruption of two vital functions that serve as life’s maps and compass. Respectively, imaginative functioning conjures what we could do, while our ethical functioning evaluates what we should (Jesudason, 2025). On this view, illness becomes life changing when it disables the prospective imagination with which we normally create our lives. Retrospection and interoception take over as we interrogate the past for causes and the body for threats (Horhota et al, 2012; Fani et al, 2024; Opdensteinen et al, 2025). Pre-occupied, we struggle to envision a future, losing trust in it. Ethical evaluations then curdle into recriminations, as we lose our sense of the right way to turn. Being creative and evaluative, these two functions shape what we make of our other capabilities, so their disruption by illness is of wide consequence, particularly when seeking to rebuild. Despite this importance, such imaginative and ethical dysfunction is commonly just medicated, labelled respectively as anxiety and low mood. Alongside talking therapies, these generic approaches can leave patients with troubling and particular medical concerns. This editorial argues, instead, for the specific rehabilitation of imaginative and ethical functioning, using expert medical counsel from specialists in Physical and Rehabilitation Medicine (PRM). While medical specialties often focus on minimising mortality and morbidity, PRM advocates a broader view of life, with emphasis on functioning as a key marker of health (Stucki and Bickenbach, 2017). Pursuing health rather than just the limitation of disease, the specialty uses the World Health Organisation’s International Classification of Functioning, Disability and Health (ICF) to work across the range of human capabilities, from biophysical to psychosocial (World Health Organization, 2001).Item Perspective Chapter: Rekindling the Vision for Palliative and End-of-Life Care for Future Practices(IntechOpen, 2025-02-05) Haraldsdottir, Erna; Bullock, KarenThis chapter will focus on the original philosophy of palliative care as developed by Dame Cicely Saunders. Attention will be paid to the development of palliative care and the challenges to remain close to the original vision as practice develops further within a traditional medical environment. The overall purpose and focus of the chapter are for the reader to engage with the inherent holistic and person-centered approach of palliative and end-of-life care as developed by Cicely Saunders and to gain an understanding and insight into how to maintain her vision as an essential element of care within modern palliative and end-of-life care.Item Pharmacist Review of Medicines Following Ambulance-Attended Falls—A Multi-Methods Evaluation of a Quality Improvement Initiative(MDPI AG, 2025-10-18) Mulrooney, William; Wilson, Caitlin; Pilbery, Richard; Fisher, Ruth; Whiterod, Sarah; Smith, Heather; Turner, Emily; Edmonds, Heather; Webster, Peter; Prestwich, Graham; Bell, Fiona; McLaren, RebeccaBackground: Falls in older adults are a leading cause of morbidity, particularly when compounded by polypharmacy. There is mixed evidence of the efficacy of medicine reviews, but there is little work exploring this in the ambulance setting. A new referral pathway enabling ambulance staff to connect patients to primary care pharmacists aimed to address this. This study explored staff and patient experiences with the pathway and its potential to improve medication safety after a fall. Methods: A mixed-method service evaluation was conducted to assess the implementation and impact of this pathway. Routine data from an ambulance trust and pharmacist proformas were used to address objectives relating to referral rates, clinical appropriateness, and fall recurrence. Patient and staff stakeholder perspectives were gathered through two cross-sectional surveys designed to explore emotional, behavioral, and practical responses to the intervention. Quantitative data were analyzed descriptively and using ordinal logistic regression where appropriate. Free-text responses were analyzed thematically. Results: Between May 2019 and March 2020, referrals were initiated for 775 older adults after ambulance attendance for a fall, with pharmacists completing medicine reviews on 340 patients. Survey data revealed improvements in patients’ emotional responses to their medicines. Ambulance clinicians identified patient disclosure, stockpiling, and the presence of expired medicines as key indicators of poor medicines management and valued the ability to refer patients. Conclusions: Overall, referral to the pathway demonstrates a marginal improvement in recontact rates in the short-term but does not necessarily represent an improvement in overall patient safety. The cost of such an intervention and patient expectations need further exploration to prove efficacy and patient satisfaction.Item Developing person-centred care in hospices through the voice and leadership of nursing: lessons from the United Kingdom(Frontiers Media, 2025-10-15) Haraldsdottir, Erna; Cooper, Marie; Richardson, HeatherIntroduction: Nursing leadership and the voice of nurses are crucial for developing person-centred care in hospices. Concerns have been raised that, as palliative care has evolved from its original vision and become more integrated into the mainstream healthcare system, it has increasingly become medicalised. This paper presents an emancipatory practice development programme aimed at enhancing the visibility and voice of nursing and nurse leadership to improve person-centred care in hospices across the United Kingdom. Methods: The project was a 10-month collaborative education programme for nursing practice leaders in hospices throughout the United Kingdom, running from September 2023 to July 2024. A total of 24 clinical and practice development leaders from eight different hospices participated. The Kirkpatrick model for evaluating learning programmes was adapted to create a framework for assessing the programme's outcomes and impact. The evaluation process utilised Collaborative Critical Creative Inquiry. Results: The key findings from the evaluation indicate that the programme created conditions for the participants to gain transformative insights and understanding that positively impacted their practice through emancipatory practice development. Discussion: The programme enabled leaders of person-centred care in hospices to rekindle their vision for palliative care practice. The participants became more aware of how care was constructed within their organisations and recognised the assumptions that were often taken for granted—assumptions that influenced daily care practices that sometimes leaned towards a traditional medical model. They acquired new skills and knowledge that empowered them to engage more intentionally in making changes to enhance person-centred care. Conclusion and implications for practice: Humanising healthcare is a global agenda, and within hospice care, nurses are at the heart of transforming care to be more person-centred. They are well-positioned to reclaim the core principles of palliative care, as developed by Cicely Saunders, and push back against the medical model that has overshadowed the development and integration of palliative care into current healthcare systems. Nurses are expert practitioners and leaders who hold positions of authority within their organisations. Yet, for many, their change-making potential is not realised. Innovative learning and development programmes are an essential part of humanising healthcare, and emancipatory practice development programmes can unlock nurses' potential to lead this transformation.Item Testing Realist Programme Theories on the Contribution of Lean Six Sigma to Person-Centred Cultures: A Comparative Study in Public and Private Acute Hospitals(MDPI, 2025-09-04) Teeling, Sean Paul; Baldie, Deborah; Daly, Ailish; Pierce, Anthony; Wolfe, Nicola; Fagan, Gillian; Garry, CatherinePerson-centred cultures are increasingly recognised as essential to the delivery of compassionate, safe, and effective healthcare. While Lean Six Sigma (LSS) is widely adopted as a process improvement methodology, its application is often critiqued for lacking alignment with relational or values-based care. This study aimed to test the transferability of three previously developed Programme Theories (PTs), generated through realist inquiry in a public hospital setting, within a large private acute hospital. Realist-informed adjudication workshops were conducted with interdisciplinary staff who had completed university-accredited training in LSS. Structured workbooks, visual artefacts, and thematic synthesis were used to identify how context–mechanism–outcome configurations (CMOCs) held, shifted, or evolved in the new setting. All three PTs were confirmed, with six CMOCs refined, and eight new configurations generated. Key refinements included the role of strategic intent, informal improvement communities, and intrinsic motivation. These findings suggest that values-based mechanisms underpinning person-centred LSS are not confined to public systems and may be equally active in private settings. The study confirms the explanatory strength of the original PTs while contributing new insights into their adaptability. It offers practical guidance for healthcare leaders seeking to embed person-centred improvement approaches across diverse systems, regardless of sectoral funding or governance structures.